Study Reports Vaginal Gel Can Help Improve Reversion to Normal Pap Smear

February 1, 1996
Volume 10, Issue 2

Patients reported with inflammatory atypia on Pap smears demonstrated a significantly improved rate of reversion to normal cytology following treatment with MetroGel-Vaginal (metronidazole 0.75% vaginal gel), according to a study presented at the District IV Junior Fellow meeting of the American College of Obstetricians and Gynecologists by Dr. Michael D. Randell, an obstetrician and gynecologist in Atlanta, Georgia.

Patients reported with inflammatory atypia on Pap smears demonstrateda significantly improved rate of reversion to normal cytologyfollowing treatment with MetroGel-Vaginal (metronidazole 0.75%vaginal gel), according to a study presented at the District IVJunior Fellow meeting of the American College of Obstetriciansand Gynecologists by Dr. Michael D. Randell, an obstetrician andgynecologist in Atlanta, Georgia.

Dr. Randell said this finding is important to women and theirphysicians, who are often confused about the significance andmanagement of inflammatory atypia on Pap smears. He noted thatthis problem has been estimated to occur in 5% to 10% of over50 million Pap smears performed each year.

An inflammatory Pap smear is often a marker of lower genital tractinfections -- most frequently bacterial vaginosis (BV), the mostcommon vaginal infection. Bacterial vaginosis has recently beenlinked as a possible cofactor with human papillomavirus (HPV)in the development of cervical intraepithelial neoplasia (CIN).CIN is a premalignant change in the cervical epithelium that canprogress to the development of cervical cancer.

Because of the possibility that inflammatory atypia seen on Papsmears is often due to undiagnosed bacterial vaginosis, Dr. Randellconducted a comparative study of therapies for this cytologicalcondition. In this retrospective study of 215 evaluable womendiagnosed with inflammatory atypia on Pap smears, 59 of the patientswere prescribed MetroGel-Vaginal, 52 were prescribed triple sulfacream, and 104 women received no treatment as the control group.

Of the women treated with MetroGel-vaginal, 86.4% had normal cytologyon repeat Pap smears, compared with 61.5% of those treated withtriple sulfa cream and 53.8% of those who received no treatment.

"Treatment of patients whose Pap smears were reported asinflammatory atypia with MetroGel-Vaginal substantially improvesthe rate of reversion to normal cytology based on our findingsfrom repeat Pap smears 3 months to 4 months following therapy,"said Dr. Randell in presenting the study results.

"It is now standard in my practice for women with inflammatoryatypia to receive a follow-up Pap smear for re-evaluation afterthis 3-month period," he said. "The use of MetroGel-vaginalfollowing an initial report of inflammatory atypia may help improvereversion to normal cytology upon repeat exam, obviating the needfor the patient and her physician to be concerned about a moreserious underlying cervical lesion."

Dr. Randell indicated that his work is a preliminary study andthat larger studies are needed to confirm his observations.

A recent study in Acta Obstetricia et Gynecologica Scandinavica,found that women whose Pap smears contained cells indicating BVhad a 357% increase in the incidence of CIN.